PB2687: DIGITAL-HEALTH AND REMOTE MONITORING FOR PATIENTS RECEIVING AZACITIDINE AT HOME. A FURTHER STEP TOWARDS HUMANIZATION AND PATIENT-CENTERED MEDICINE
Authors: Isabel Gonzalez-Gascon-Y-Marin, María Mir, Alejandro Santiago, Maria Angeles Foncillas Garcia, Teresa Osorio, Francisco-José Ruiz-Gómez, Maria José Solaeta, Victorino Diez, Nuria Suarez-Liceras, Carlos Bibiano-Guillén, Jose Ángel Hernández Rivas
Journal: HemaSphere (2023)

Topic: 35. Quality of life and palliative care Background: Hypomethylating agents are the backbone of the treatment for acute myeloid leukemia (AML) and high-risk myelodysplastic syndromes (MDS) in the elderly. Despite the addition of targeted therapies, the prognosis remains poor. Thus, time spent at home is one of the most desirable outcomes for these patients. A recent study has shown that the proportion of days out of the hospital for patients receiving azacitidine (AZA) +/- venetoclax (VEN) is only 0.58. In this context, we incorporated the administration of AZA within the “better@home” program with the added advantage of tele-health care and remote patient monitoring. Aims: To analyze the experience of the AZA-“better@home” program between March 2022 and February 2023 in our center. Methods: All patients receiving subcutaneous AZA or new candidates were offered to be included in this program. Treatment-naïve patients were incorporated into the program from the second cycle onwards. On day 1 of each cycle, patients are scheduled for a face-to-face visit with the hematologist and AZA is administered in the day-unit. On that day patients receive self-care training and are given and instructed in the use of a remote patient-control kit, after written consent. Patients/caregivers take their vital signs and electronically fill out daily symptom questionnaires. These data are entered into a web environment, generating green, yellow and red alarms ordered according to their severity, for the early warning of any adverse event. Nurses come to the home to administer AZA after reviewing the alarms and consult with the physician if necessary. For quality of life (QoL) analysis, EORTC QLQ-C30 ePROM was filled and customer experience was assessed by a customer satisfaction survey (CSAT). Results: Since the program began, only 2 patients refused to join arguing that they preferred to go to the hospital. With a median follow-up of 6.5 months (1.4-11.2), 73 cycles were administered to 16 patients. Patient´s characteristics are summarized in table 1. Currently, 44% of the patients (7/16) continue in the program; 44% discontinued due to progression, 1 due to a second neoplasm, while only 1 patient left by his own decision. The median proportion of days at home when patients were in the program was 0.89 (0.65-0.95). Unexpected emergency room (ER) visits were only 3 and another 5 visits were avoided thanks to telehealth. Six patients were admitted during treatment. The remote care program through its yellow and red alerts allowed early detection of: 1 cellulitis, 1 COVID-19, 2 upper respiratory infections, 1 bacterial peritonitis with early transfer for surgery and 1 disease progression. The response rate to patient-experience survey was 75%. Satisfaction was really high with a CSAT score of 90.7%. Besides, only 1 patient would not recommend the program. The baseline QoL survey was completed by 16/17 patients and, as expected, the global health status (GHS) was poor with a median score of 58 (33-91) on a scale of 0-100. In contrast, perception of functional well-being was high with median scores above 80 in physical, role, emotional, cognitive and social functioning. Summary/Conclusion: Administration of AZA in home care with a telehealthcare approach proved to be feasible and safe for an elderly population with a short estimated survival and an impaired QoL. It allowed to increase patient´s time at home, to reduce unexpected visits to the ER and to anticipate hospital admissions, which was accompanied by a really high satisfaction level among users. Table 1.Keywords: Acute myeloid leukemia, Quality of life, Myelodysplastic syndrome